PREVENTIVE HEALTH ASSISTANCE (PHA) PROGRAM

Important Information

As of August 1, 2016, participants interested in the Weight Management (WM) Program will need to contact their Primary Care Provider to obtain the WM Agreement Form.

Weight Management Program Information

Preventive Health Assistance(PHA), is a benefit for Medicaid participants. The Weight Management PHA provides opportunities designed to help eligible participants and their families improve their lifestyle through:

Physical Fitness

Balanced Diet

Personal Health Education

Note: Participants on the Home Care for Certain Disabled Children Program (Katie Beckett) and Medicare Medicaid Coordinated Plan participants are not eligible for PHA benefits.

Weight Management

To qualify for the benefit, the participant must be over the age of five, have Basic or Enhanced Medicaid coverage, and meet the following weight criteria:

Adults: a body mass index (BMI) of 30 or higher or 18.5 or lower.

Children: a body mass index (BMI) that falls in either the overweight or the underweight category.

Qualifying participants can earn up to $200 each year to help pay for services offered by PHA providers such as Fees for a weight management program, Healthy lifestyle classes, or nutrition classes or services. The benefit will start on the date of approval.

Primary Care Providers (PCP) will be initiating the process of filling out the WM Agreement Form. After the PCP fills out their portion of the form the participant is responsible for filling out their section of the form, choosing a WM Vendor, taking the form to the vendor for them to sign, and then submitting the form for approval.

Don't forget to complete all sections of the form before submitting it for approval or the form will be returned to the participant for completion and the process will be delayed.

Children's Wellness Benefit

The Wellness PHA is a program that provides parents of children on the Children's Health Insurance Program (CHIP) an additional benefit for keeping their children up to date on well child checks and immunizations.

Children's Health Insurance Program (CHIP) is a low-cost health coverage program for children under age 19 whose family income is too high to qualify for Medicaid. There may be a small monthly premium ($10 or $15, depending on your income) for each child enrolled in CHIP. To qualify for CHIP a child must:

Live in Idaho, be under the age of 19, be a U.S. citizen or legal resident, and be within the family income guidelines.

Children who have private health insurance do not qualify for CHIP.

If your child is on CHIP and you pay a monthly premium for your child’s Medicaid coverage, your child is eligible for the wellness PHA benefit. By keeping your child’s well-child checks and immunizations current you can qualify to receive a $10 deduction in your monthly premiums.

If you have additional questions about if your child is eligible for CHIP please contact (877) 456-1233.